Disclosed are devices and methods of treating an ocular disorder including forming a self-sealing incision in a cornea into an anterior chamber of an eye; introducing through the incision a fluid drainage tube having a distal end, a proximal end and a longitudinal, internal lumen extending through the fluid drainage tube, wherein at least the proximal end passes through the anterior chamber; and implanting the distal end of the fluid drainage tube in fluid communication with the suprachoroidal space such that the proximal end of the fluid drainage tube remains in fluid communication with the anterior chamber.

Patent
   9351873
Priority
Nov 14 2003
Filed
Mar 06 2014
Issued
May 31 2016
Expiry
Nov 14 2023
Assg.orig
Entity
Large
2
403
EXPIRED<2yrs
1. An ocular implant system for implanting an ocular device into the eye, comprising:
a fluid drainage device configured to be deployed in the eye so as to locate a first end of the fluid drainage device in communication with the suprachoroidal space, the fluid drainage device having an internal lumen wherein a first end of the lumen of the drainage device communicates with the suprachoroidal space and a second end of the lumen of the drainage device opens into the anterior chamber, and the lumen is positioned in a space between the ciliary body and the sclera when implanted in a deployed location in the eye such that the internal lumen provides a fluid passageway from the anterior chamber towards the suprachoroidal space, so as to provide aqueous pressure regulation by draining aqueous humor from the anterior chamber towards the suprachoroidal space via the internal lumen, said fluid drainage device configured to be inserted into the eye through a self-sealing incision in the cornea and wherein the fluid drainage device has a second end configured to be located inside the anterior chamber such that the second end is outside of the ciliary body and posterior of an inner surface of the cornea when in the deployed location, and wherein the fluid drainage device has a length sufficient to extend from the anterior chamber to the choroid when implanted, and wherein the first end of the device includes a round, foldable plate adapted to locate the device on the inner surface of a sclera of the eye; and
an introducer cannula that couples to the fluid drainage device, the cannula having a plunger wherein the fluid drainage device can be detached from the cannula by pressing the plunger into the introducer.

This application is a continuation of co-pending U.S. application Ser. No. 12/905,003, filed Oct. 14, 2010, entitled “OCULAR PRESSURE REGULATION” by Minas Coroneo, which is a continuation of U.S. application Ser. No. 11/615,642, filed Dec. 22, 2006, entitled “OCULAR PRESSURE REGULATION” by Minas Coroneo, now U.S. Pat. No. 8,128,588, issued Mar. 6, 2012, which is a continuation of U.S. application Ser. No. 10/712,277, filed Nov. 14, 2003, entitled “OCULAR PRESSURE REGULATION” by Minas Coroneo, now U.S. Pat. No. 7,291,125, issued Nov. 6, 2007.

This application also is related to U.S. application Ser. No. 10/579,330, filed Nov. 12, 2004, entitled “OCULAR PRESSURE REGULATION” by Minas Coroneo, now U.S. Pat. No. 8,486,000, issued Jul. 16, 2013; and to U.S. application Ser. No. 11/615,615, Dec. 22, 2006, entitled “OCULAR PRESSURE REGULATION” by Minas Coroneo, now U.S. Pat. No. 7,850,638, issued Dec. 14, 2010; and to U.S. application Ser. No. 12/107,676, filed on Apr. 22, 2008, entitled “OCULAR PRESSURE REGULATION” by Minas Coroneo, now U.S. Pat. No. 7,815,592, issued Oct. 19, 2010.

Where permitted, the subject matter of each of the above noted applications is incorporated by reference in its entirety by reference thereto.

This invention is directed to therapeutic methods and devices for the treatment of glaucoma. In particular, this invention is concerned with the use of a shunt or drain for the treatment of glaucoma. In another aspect this invention is concerned with ocular pressure spike shunts and use of the same in ocular surgery.

The glaucomas are a common group of blinding conditions usually associated with elevated intraocular pressure. This elevated pressure in the eye may be regarded as a disorder of the drainage system of the eye which gives rise to the glaucomas.

Aqueous humor of the eye (“aqueous”) is a flowing liquid fluid (composed of sodium, chloride, bicarb, amino acids, glucose, ascorbic acid, and water) that is actively secreted by the ciliary body and flows out past the iris into the anterior chamber (are between the lens/iris and the cornea). The aqueous drains out through angle formed by the iris and the sclera into a meshwork call the trabeculum, and from there into the canal of Schlemm and then into the episcleral veins. Uveosclera drainage also occurs. Normal intraocular pressure (IOP) of aqueous in anterior chamber is between 10 and 20 mm Hg. Prolonged IOPs of greater than 21 mm Hg are associated with damage to optic nerve fibers.

In some cases of glaucoma the cause can be found: the trabecular meshwork becomes blocked by pigment or membrane. In other cases, blockage is due to a closure of the angle between the iris and the cornea. This angle type of glaucoma is referred to as “angle-closure glaucoma”. In the majority of glaucoma cases, however, called “open angle glaucoma”, the cause is unknown.

Elevated intraocular pressure results in the death of retinal ganglion cells (which convey retinal information to the brain) resulting in a characteristic pattern of loss of the field of vision, progressing to tunnel vision and blindness if left untreated.

Treatment of glaucoma consists predominantly of methods to lower the intraocular pressure (pharmacological, trabecular meshwork laser and surgery to drain fluid from the eye). More recently protection of the retinal ganglion cells by neuroprotective agents has been attempted.

Although pharmacological treatments of glaucoma have improved, they have important implications for the patient's quality of life, have compliance issues which are important in the elderly (in whom glaucoma is prevalent), expose the patient of glaucoma to side effects, and over a lifetime are costly.

Surgery for glaucoma treatment is usually a trabeculectomy in which a fistula is created to drain fluid from the anterior chamber to the subconjunctival space near the limbus, creating a bulge in the conjunctiva known as a bleb. Frequently scarring occurs and attempts to counter this with antimetabolites such as Mitomycin C have met with some success. In recalcitrant cases, glaucoma implants, drainage, shunt or valve devices have been developed e.g. Molteno (U.S. Pat. No. 4,457,757), Krupin (U.S. Pat. No. 5,454,746) and Baerveldt (U.S. Pat. No. 5,178,604). These suffer from similar problems of scarring (Classen L, Kivela T, Tarkkanen “A Histopathologic and immunohistochemical analysis of the filtration bleb after unsuccessful glaucoma seton implantation” Am J Ophthalmol, 1996;122:205-12) around the external opening of the tube devices in the subconjunctival space—the development of a large number of these devices is testament to the fact that many fail in the longer term. In these devices a drainage tube is located in the anterior chamber and is in fluid communication with the sclera or a surgically created subconjunctival space.

Whereas cataract surgery has been revolutionized in the last two decades, improvements in glaucoma surgery have been slower. Antifibrotic agents have improved the success rate of conventional filtration surgery (trabeculectomy), but with increased bleb leaks, blebitis, endophthalmitis and hypotensive maculopathy. Glaucoma shunts have had limited success in eyes that have “failed” multiple standard procedures. However complications with malpositioned tubes, erosion and strabismus persist. A considerable issue is the lack of reproducibility and predictability in achieving the desired target intraocular pressure (IOP). Final IOP is largely determined by healing which can be unpredictable—in view of vast biological variations, it is impossible to predict which eyes will rapidly scar causing failure and which will fail to heal resulting in prolonged post-operative hypotony. Scarring remains a significant problem in all these external drainage proposals, where aqueous drains into the conjunctiva, or surgical chambers in the sclera.

The introduction of a new class of antiglaucoma drugs, the prostaglandin analogues, has resulted in acknowledgment of the importance of the uveoscleral pathway in drainage of fluid form the eye (Hylton C, Robin A L “Update on prostaglandin analogs” Curr Opin Ophthalmol, 2003;14:65-9). Uveoscleral flow where aqueous humor flows through the interstitium of the ciliary muscle into the suprachoroidal space (a potential space between the choroids and sclera) and out through the sclera into the connective tissue of the orbit may account for 54% of outflow young healthy humans (Toris C B, Yablonski M E, Wang Y L, Camras C B “Aqueous humor dynamics in the aging human eye” Am J Ophthalmol, 1999;127:407-12).

Cyclodialysis, the separation of the ciliary body from the scleral spur and underlying sclera, creates free communication between the anterior chamber and the suprachoroidal space and enhances uveoscleral flow. It has long been known that cyclodialysis can cause a profound reduction of intraocular pressure—initially (Fuchs E. “Detachment of the choroid inadvertently during cataract surgery” [German] von Graefes Arch Ophthalmol, 1900;51:199-224) cyclodialysis was recognized as a complication of cataract surgery. Deliberate creation of a cyclodialysis cleft for treating elevated intraocular pressure in uncontrolled glaucoma was first described as a surgical procedure in 1905 (Heine I. “Cyclodialysis, a new glaucoma operation” [German]) Dtsch Med Wochenschr, 1905;31:824-826). Since such clefts can heal and close spontaneously a number of devices have been used to keep them open, including platinum wire, horse hair, magnesium strips, tantalum foil, Supramid®, gelatin film, Teflon®, silicone and polymethylmethacrylate (Rosenberg L F, Krupin T. “Implants in glaucoma surgery” Chapter 88, The Glaucomas, Ritch R, Shields B M, Krupin T Eds. 2nd Edition Mosby St Louis 1986) and Hema (Mehta K R. “The suprachoroidal Hema wedge in glaucoma surgery” American Academy of Ophthalmology meeting 1977, pp 144). However the success rate of such approaches has been low (as low as 15%, Rosenburg & Krupin ibid and Gross R L, Feldman R M, Spaeth G L, et al “Surgical therapy of chronic glaucoma in aphakia and pseudophakia” Ophthalmology, 1988;95:1195-201). Failure was due to uncontrolled low pressure (hypotony) with consequential macular edema, bleeding (hyphema) and inadequate pressure control.

The device and method of a first aspect of this invention takes advantage of the methods used in cataract surgery to develop a minimally invasive glaucoma procedure—thus small, self sealing incisions and materials that are biocompatible and foldable so that they fit through small openings will reduce surgical trauma and time. The controlled draining of aqueous into the suprachoroidal space according to this invention provides some predictability of outcome and overcomes scarring problems that have plagued glaucoma implants in the past.

The most frequent complication following modern cataract surgery with phacoemulsification, requiring specific treatment is elevated intraocular pressure (Cohen V M, Demetria H, Jordan K, Lamb R J, Vivian A J. :First day post-operative review following uncomplicated phacoemulsification” Eye, 1998;12 (Pt 4):634-6, and Dinakaran S, Desai S P, Raj PS. “Is the first post-operative day review necessary following uncomplicated phacoemulsification surgery?” Eye, 2000 Jun; 14 (Pt 3A):364-6). The increase may be marked and typically peaks at 5 to 7 hours before returning to near normal levels in 1 to 3 days (Hildebrand G D, Wickremasinghe S S, Tranos P G, Harris M L, Little B C. “Efficacy of anterior chamber decompression in controlling early intraocular pressure spikes after uneventful phacoemulsification” J Cataract Refract Surg., 2003; 29:1087-92). Such pressure spikes can cause pain and may increase the risk of sight-threatening complications such as retinal vascular occlusion, increases loss of visual field in advanced glaucoma and ischemic optic neuropathy—effects in otherwise healthy eyes are unknown (Hildebrand G D et al, ibid).

A number of prophylactic treatments are used with limited success—these include intracameral carbachol or acetylcholine, topical timolol, dorzolamide, aproclonidine, latanoprost and systemic acetazolamide (see Hildebrand G D et al, ibid). This also exposes the patient to the risk of drug side effects, increased cost and it has been postulated that reducing the flow of aqueous humor post surgery prolongs the residence time of bacteria that frequently (46.3% of cases) contaminate the anterior chamber during surgery (Srinivasan R, Tiroumal S, Kanungo R, Natarajan M K. “Microbial contamination of the anterior chamber during phacoemulsification” J Cataract Refract Surg, 2002; 28:2173-6.). This may increase the risk of endophthalmitis one of the most devastating sequelae of intraocular surgery, since the bacteria are not being “flushed out” of the eye by the normal production of aqueous humour, the secretion of which has been suppressed by the drugs. Another technique is to decompress the anterior chamber by applying pressure to the posterior lip of the paracentesis wound at the appropriate time. This requires surveillance and could increase the risk of infection. Another aspect of this invention hereinafter described overcomes these problems.

According to the present invention there is provided a flexible ocular device for implantation into the eye formed of a biocompatible elastomeric material, foldable to a diameter of 1.5 mm or less, comprising a fluid drainage tube having at one end a foldable plate adapted to locate the device on the inner surface of the sclera in a suprachoroidal space formed by cyclodialysis, said drainage tube opening onto the disc at one end and opening to the anterior chamber when implanted into the eye at its other end, so as to provide aqueous pressure regulation.

Preferably the fluid drainage tube has a diameter selected to provide predetermined resistance to aqueous humor flow, for example a pressure of 10 mm Hg or less. Alternatively said tube contains a valve so as to regulate pressure of the aqueous chamber at a predetermined level, for example, at no less than 10 mm Hg.

In accordance with another embodiment of this invention there is provided a method for treating glaucoma which comprises:

providing a flexible ocular device formed of a biocompatible elastomeric material foldable to a diameter of 1.5 mm or less, comprising a fluid drainage tube having at one end a foldable plate adapted to locate the device on the inner surface of the sclera and at its other end being open so as to allow fluid communication through said tube;

forming a small self-sealing incision at the juncture of the cornea and sclera of the eye opening into the anterior chamber;

filling the anterior chamber with a viscoelastic substance;

introducing the foldable ocular device into a suprachoroidal space formed by cyclodialysis via a hollow cannula, wherein said plate locates the device on the inner surface of the sclera in the suprachoroidal space, and said drainage tube is located in the anterior chamber of the eye so as to provide aqueous humor pressure regulation; and

thereafter removing said cannula and viscoelastic material from the eye.

In another aspect there is provided an ocular pressure spike shunt for insertion into an ocular paracentesis incision port following ocular surgery, comprising a flexible fluid transfer tube formed of biocompatible material, preferably biocompatible elastomeric material, so as to allow paracentesis incision closure around said tube, having an inner end and an outer end, a tubular lumen disposed between said inner end and said outer end to allow fluid communication through said tube, said lumen containing a valve for controlling pressure in the eye following ocular surgery, which valve opens permitting fluid flow through said tube when a predetermined pressure is exceeded, said shunt being configured such that on insertion into a paracentesis port said outer end is substantially flush with the surface of the cornea, and said inner end opens into the anterior chamber of the eye.

In another aspect there is provided a method for preventing ocular pressure spikes following ocular surgery wherein a paracentesis incision port is formed in the eye during said surgery, comprising introducing an ocular pressure spike shunt into said paracentesis port at the conclusion of ocular surgery, said shunt comprising a flexible fluid transfer tube formed of biocompatible material, preferably biocompatible elastomeric material, so as to allow paracentesis incision closure around said tube, having an inner end and an outer end, a tubular lumen disposed between said inner end and said outer end to allow fluid communication through said tube, said lumen containing a valve for controlling pressure in the eye following ocular surgery, which valve opens permitting fluid flow through said tube when a predetermined pressure is exceeded, said shunt being configured such that on insertion into a paracentesis port said outer end is substantially flush with the surface of the cornea, and said inner end protrudes into the anterior chamber of the eye.

FIG. 1 shows a diagrammatic representation of a side sectional view of suprachoroidal shunt insertion using an injector.

FIG. 2 shows a diagrammatic representation of a side sectional view of an eye showing the unfolded plate portion of the device and a cannula introducing said device across the anterior chamber at 180° to the site of insertion.

FIG. 3 shows a diagrammatic representation of an eye containing a pressure spike shunt inserted into a paracentesis port.

FIG. 4 shows a perspective view of another embodiment of an ocular device described herein.

The ocular device according to the present invention is implanted in a patient's eye using minimally invasive surgery techniques, adopted from modern cataract surgery.

The ocular device is formed from a biocompatible elastomeric material. Preferably, the device is made of soft surgical grade polymeric material, such as silicon or acrylic material such that the device is foldable and may be rolled up for insertion via a cannula. FIG. 1 shows a proximal end of a cannula forming a cyclodialysis. The folded device may be introduced via such a cannula The elastomeric material is selected to be sufficiently soft that it does not erode delicate underlying choroid material when inserted into the eye. Such material and ocular lenses formed therefrom are well known and used in cataract surgery.

Sutures are not required to hold the device in place once surgically introduced into the eye, as the foldable plate is adapted to locate the device on the inner surface of the sclera in a suprachoroidal space formed by cyclodialysis (FIG. 2). Preferably, the plate is of a disc-like shape which matches the curvature of the eye once unfolded. FIG. 2 depicts an unfolded disc (connected tube not shown) after cannula introduction across the anterior chamber (transcameral). Alternatively, any plate-like configuration which locates the device on the inner surface of the sclera in the suprachoroidal space may be used, such as for example a rectangular foldable plate. Preferably the plate diameter is from 0.05 to 6 mm, and preferably the place thickness is from 12.5 μm to 250 μm. The fluid drainage tube of the ocular device is preferably integral with the plate, and is attached at one end to the plate, preferably at the periphery of the plate. Alternatively, the tube may be microwelded or otherwise fixed to the plate. Fabrication techniques well known in production of intraocular foldable lenses are preferably used in this invention. The tube has a hollow lumen, and is preferably of a length from about 1 mm to 4 mm. Preferred diameters of the tubing comprise an outer diameter of 400-1000 μm, and preferably the inner diameter is from 50 to 500 μm.

The diameter of the tube may be selected so as to provide a resistance to aqueous humor flow of predetermined pressure, preferably being a pressure less than 10 mm Hg. This enables the pressure of the aqueous to be regulated in a controlled manner, providing relief from excess ocular pressure associated with glaucoma, with avoidance of hypotony (uncontrolled low pressure). Alternatively, the tube may contain a valve, for example disposed at the end of the tube opening onto the disc so as to regulate ocular pressure at a predetermined level. Preferably, the valve prevents aqueous flow through the tube at a pressure of less than 10 mm Hg. Examples of valves which may be used include a slit valve. The drainage stops altogether if the pressure drops to a predetermined threshold level controlled by the valve.

The flexible foldable nature of the device according to the present invention enables well established techniques used in cataract surgery to be employed in the treatment of glaucoma. The device according to the present invention may be folded into a cannula and introduced for location into the eye.

Intraocular surgery techniques allow a paracentesis (opening onto the anterior chamber from without at the juncture of the cornea and sclera—the limbus) to be performed and the anterior chamber filled with viscoelastic substance. A cyclodialysis instrument is introduced via the paracentesis, with the paracentesis preferably being carried out 180° from the insertion site. A cyclodialysis is carried out, for example by advancing an instrument tip into the angle between the ciliary body and sclera so as to create a cyclodialysis. This is preferably carried out with direct visualisation via gonioscopy lens viewed through an operating microscope. A surgical gonioscopy lens is preferably placed on the cornea while the cyclodialysis is carried out.

The rolled up ocular device is introduced through a cannula, for example using an introducer such as used in cataract surgery or other ocular surgery, from which the device can be detached by pressing a plunger into the introducer when the device has been inserted into the suprachoroidal space created by the cyclodialysis. The tubing of the device is positioned into the interior chamber, and the plate unfolds in the suprachoroidal space to locate the device in the eye. Because of its size, the device cannot fall through the opening through which it was introduced into the suprachoroidal space by the cyclodialysis. The plate therefore keeps the tube in the appropriate position in the anterior chamber allowing controlled aqueous drainage and providing an effective treatment for elevated ocular pressure.

The pressure spike shunt is designed to fit snugly in a paracentesis port that is routinely made during cataract or other ocular surgery. The tubing will not distort the port and there will be no leakage around the port. The outer end of the tube will sit flush on the surface of the cornea—the inner aspect of the tube will preferably just protrude into the anterior chamber—tube length will generally be 1-2 mm and tube diameter is preferably from 0.4-1.2 mm. The tube will contain the same valvular device as contained in the ocular device described above and will open when the intraocular pressure exceeds a predetermined level, preferably 10 mm Hg. At normal ocular pressure the valve will be closed, closing said tube to any fluid communication. FIG. 3 shows a shunt located in a paracentesis port. In most cases the shunt will be removed and discarded at the first post-operative dressing.

The shunt may be inserted into a paracentesis port, or one or more ports, using, for example, a punctum plug inserting instrument such as described in U.S. Pat. No. 5,741,292.

This invention will now be described with reference to the following examples.

Fresh whole porcine eyes were taken and mounted in a temperature controlled)(37°) perfusion chamber. The eyes were perfused with Balanced Salt Solution via a 30 gauge needle inserted via a paracentesis into the anterior chamber. A peristaltic pump was used at a flow rate of 2 μl/min. Intraocular pressure was continuously monitored via a second paracentesis.

Typically intraocular pressures stabilized at 10-15 mm Hg and fell with time (the “washout effect”, as glycosan aminoglycans are washed out of the trabecular meshwork with time). Creation of a cyclodialysis (initially with a small spatula, then viscoelastic injection to enlarge the area of detachment of the ciliary body from the sclera) with or without insertion of the device in the cyclodialysis cleft (silicone tubing, length 3 mm, external diameter—1 mm, plate diameter 3 mm) resulted in lower intraocular pressures (below 10 mm Hg) on reperfusion at the same perfusion rate as control eyes.

Adequate anesthesia is provided to the eye of a glaucoma patient prepared for intraocular surgery. A paracentesis (opening into anterior chamber from without at the junction of the cornea and sclera—the limbus) is performed and the anterior chamber is filled with a viscoelastic substance. A surgical gonioscopy lens is placed on the cornea (or anterior segment endoscope is used) and a cyclodialysis instrument is introduced via the paracentesis—the paracentesis is carried out 180° away from the planned implant insertion site. The cyclodialysis instrument tip is advanced into the angle and pushed into the space between the ciliary body and sclera creating a cyclodialysis—this is carried out with direct visualization via the gonioscopy lens viewed through an operating microscope. In order to minimize bleeding, the area in the angle (anterior ciliary body face and overlying trabecular meshwork) can be lasered either preoperatively or at the time of surgery to ablate surface blood vessels).

Through an opening at the tip of the cyclodialysis instrument viscoelastic is inserted to further create a space in the suprachoroidal space. The implant is then introduced—the device is rolled up in the same manner as an ultrathin intraocular lens. The ocular device is attached to an introducer from which it is detached by pushing a plunger in the introducer when the implant is inserted into the suprachoroidal space created by the cyclodialysis instrument and viscoelastic. The tubing is then positioned into the anterior chamber and may be cut to size. The plate unfolds in the suprachoroidal space and because of its size cannot fall through the opening through which it was introduced into the suprachoroidal space. The plate therefore keeps the tube in an appropriate position. The valve is then flushed (with a cannula inserted via the paracentesis) via the tube opening in the anterior chamber. Viscoelastic is then removed from the anterior chamber and antibiotics, steroids and a dressing applied to the eye.

Fresh whole porcine eyes were taken and mounted in a temperature-controlled (37°) perfusion chamber as in Example 1. The eyes were perfused with Balanced Salt Solution via a 30 gauge needle inserted via a paracentesis into the anterior chamber. A peristaltic pump was used at a flow rate of 2 μl/min. Intraocular pressure was continuously monitored via a second paracentesis.

Typically intraocular pressures stabilized at 10-15 mm Hg and fell with time (the “washout effect, as glycoaminoglycans are washed out of the trabecular meshwork with time). Silicone tubing (length 3 mm, external diameter 1 mm) was introduced into one paracentesis port. One end of the port (outer end) was flush with the cornea and the inner end of the port extended slightly into the anterior chamber. Intraocular pressure did not exceed 10 mm Hg.

Coroneo, Minas Theodore

Patent Priority Assignee Title
11045355, Jun 14 2019 Iantrek, Inc. Implantable biologic stent and system for biologic material shaping, preparation, and intraocular stenting for increased aqueous outflow and lowering of intraocular pressure
11925580, Jun 14 2019 Iantrek, Inc. Implantable biologic stent and system for biologic material shaping and preparation in the treatment of glaucoma
Patent Priority Assignee Title
2990670,
3439675,
3767759,
3788327,
3915172,
4037604, Jan 05 1976 SOUTH SHORE BANK, A TRUST COMPANY OF MA Artifical biological drainage device
4402681, Aug 23 1980 Artificial implant valve for the regulation of intraocular pressure
4457757, Jul 20 1981 Device for draining aqueous humour
4521210, Dec 27 1982 WONG, VERNON G Eye implant for relieving glaucoma, and device and method for use therewith
4554918, Jul 28 1982 Ocular pressure relief device
4604087, Feb 26 1985 Aqueous humor drainage device
4617715, Aug 03 1982 Oy Tampella Ab Method for preliminary anchoring of a wire rope bolt
4634418, Apr 06 1984 Hydrogel seton
4722724, Jun 23 1986 Anterior chamber tube shunt to an encircling band, and related surgical procedure
4750901, Mar 07 1986 Implant for drainage of aqueous humour
4787885, Apr 06 1984 Hydrogel seton
4826478, Jun 23 1986 Anterior chamber tube shunt to an encircling band, and related surgical procedure
4846172, May 26 1987 Laser-delivery eye-treatment method
4863457, Nov 24 1986 Drug delivery device
4886488, Aug 06 1987 Siemens Plessey Electronic Systems Limited Glaucoma drainage the lacrimal system and method
4900300, Jul 06 1987 Surgical instrument
4946436, Nov 17 1989 CLOUD FARM ASSOCIATES L P Pressure-relieving device and process for implanting
4968296, Dec 20 1989 I-MED DEVELOPMENT CORPORATION, A CORP OF DE Transscleral drainage implant device for the treatment of glaucoma
5041081, May 18 1990 ODRICH, STEVEN A Ocular implant for controlling glaucoma
5071408, Oct 07 1988 NEW WORLD MEDICAL, INCORPORATED, Medical valve
5073163, Jan 29 1990 LIPPMAN, JOEL H Apparatus for treating glaucoma
5092837, Dec 20 1989 I-MED DEVELOPMENT CORPORATION, A CORP OF DE Method for the treatment of glaucoma
5127901, May 18 1990 ODRICH, STEVEN Implant with subconjunctival arch
5171213, Aug 14 1991 Technique for fistulization of the eye and an eye filtration prosthesis useful therefor
5178604, May 31 1990 Abbott Medical Optics Inc Glaucoma implant
5180362, Apr 03 1990 Gonio seton
5284476, Mar 20 1992 Nuclear hydrolysis cannula
5300020, May 31 1991 L ESPERANCE MEDICAL TECHNOLOGIES, INC Surgically implantable device for glaucoma relief
5338291, Feb 03 1993 Medtronic, Inc Glaucoma shunt and method for draining aqueous humor
5342370, Mar 19 1993 University of Miami Method and apparatus for implanting an artifical meshwork in glaucoma surgery
5346464, Mar 10 1992 Method and apparatus for reducing intraocular pressure
5370607, Oct 28 1992 Annuit Coeptis, Inc. Glaucoma implant device and method for implanting same
5372577, Apr 11 1988 Apparatus for reducing intraocular pressure
5397300, May 31 1990 Abbott Medical Optics Inc Glaucoma implant
5423777, Oct 27 1993 Punctum plug
5433701, Dec 21 1994 SOLX, INC Apparatus for reducing ocular pressure
5443505, Nov 15 1993 Allergan, Inc Biocompatible ocular implants
5454746, Jan 06 1994 MECCANO S N Toy hand tool
5476445, May 31 1990 Abbott Medical Optics Inc Glaucoma implant with a temporary flow restricting seal
5558629, May 31 1990 Abbott Medical Optics Inc Glaucoma implant
5558630, Dec 30 1994 Intrascleral implant and method for the regulation of intraocular pressure
5601094, Nov 22 1994 Ophthalmic shunt
5626558, May 05 1995 Adjustable flow rate glaucoma shunt and method of using same
5626559, May 02 1994 Ramot University Authority for Applied Research and Industrial Ophthalmic device for draining excess intraocular fluid
5651782, Mar 19 1993 University of Miami Method and apparatus for implanting an artificial meshwork in glaucoma surgery
5676944, Oct 06 1993 The Regents of the University of California Ocular therapy with homologous macrophages
5702414, May 14 1995 Optonol Ltd Method of implanting an intraocular implant
5704907, Jul 22 1994 WOUND HEALING OF OKLAHOMA, INC Method and apparatus for lowering the intraocular pressure of an eye
5713844, Jan 10 1997 MINU, L L C Device and method for regulating intraocular pressure
5741292, Oct 26 1995 KATENA PRODUCTS, INC Punctum dilating and plug inserting instrument with push-button plug release
5743868, Feb 14 1994 Corneal pressure-regulating implant device
5749879, Aug 16 1989 Medtronic, Inc Device or apparatus for manipulating matter
5752928, Jul 14 1997 RDO Medical, Inc. Glaucoma pressure regulator
5792075, Apr 11 1995 Boston Scientific Corporation Method and apparatus for extending the length of a guide wire
5807244, Nov 15 1996 Single use disposable iris retractor
5807302, Apr 01 1996 Treatment of glaucoma
5868697, May 14 1995 Optonol Ltd. Intraocular implant
5882327, Apr 17 1997 Board of Supervisors of Louisiana State University and Agricultural and Mechanical College Long-term glaucoma drainage implant
5893837, Feb 28 1997 STAAR SURGICAL COMPANY, INC Glaucoma drain implanting device and method
5941250, Nov 21 1996 University of Louisville Research Foundation, Inc Retinal tissue implantation method
5968058, Mar 27 1996 Optonol Ltd. Device for and method of implanting an intraocular implant
6007510, Oct 25 1996 REVISION OPTICS, INC Implantable devices and methods for controlling the flow of fluids within the body
6007511, May 08 1991 Shunt valve and therapeutic delivery system for treatment of glaucoma and methods and apparatus for its installation
6019786, Oct 11 1995 LifeShield Sciences LLC Braided composite prosthesis
6036678, Feb 28 1995 Photogenesis, Inc. Method for preparation and transplantation of planar implants and surgical instrument therefor
6050970, May 08 1997 Abbott Medical Optics Inc Method and apparatus for inserting a glaucoma implant in an anterior and posterior segment of the eye
6050999, Dec 18 1997 ADDITION TECHNOLOGY, INC Corneal implant introducer and method of use
6077299, Jun 22 1998 Eyetronic, LLC Non-invasively adjustable valve implant for the drainage of aqueous humor in glaucoma
6102045, Jul 22 1994 WOUND HEALING OF OKLAHOMA, INC Method and apparatus for lowering the intraocular pressure of an eye
6142969, Oct 25 1996 REVISION OPTICS, INC Sutureless implantable device and method for treatment of glaucoma
6152918, Apr 05 1996 Eclipse Surgical Technologies, Inc.; Eclipse Surgical Technologies, Inc Laser device with auto-piercing tip for myocardial revascularization procedures
6174307, Mar 29 1996 Eclipse Surgical Technologies, Inc. Viewing surgical scope for minimally invasive procedures
6186974, Jan 10 1997 University College London and Moorfields Eye Hospital NHS Trust Device for use in the eye
6203513, Nov 20 1997 Optonol Ltd. Flow regulating implant, method of manufacture, and delivery device
6221078, Jun 25 1999 Surgical implantation apparatus
6251090, Dec 12 1994 ROBERT L AVERY Intravitreal medicine delivery
6261256, Dec 20 1996 Pocket medical valve & method
6264668, Sep 16 1998 Ophthalmologic instrument for producing a fistula in the sclera
6270472, Dec 29 1998 University of Pittsburgh of the Commonwealth System of Higher Education Apparatus and a method for automatically introducing implants into soft tissue with adjustable spacing
6331313, Oct 22 1999 Allergan, Inc Controlled-release biocompatible ocular drug delivery implant devices and methods
6375642, Feb 15 2000 Alcon Inc Method of and device for improving a drainage of aqueous humor within the eye
6383219, Feb 17 1997 Corneal Industrie Implant for deep sclerectomy
6450984, Apr 26 1999 Glaukos Corporation Shunt device and method for treating glaucoma
6464724, Apr 26 1999 Glaukos Corporation Stent device and method for treating glaucoma
6468283, May 14 1995 Optonol, Ltd. Method of regulating pressure with an intraocular implant
6471666, Feb 24 2000 Alcon Inc Injectable glaucoma device
6471777, Oct 20 1998 Murata Manufacturing Co., Ltd. Holder for electroless plating and method of electroless plating
6494857, Sep 02 1998 Device for improving in a targeted manner and/or permanently ensuring the ability of the aqueous humor to pass through the trabecular meshwork
6508779, May 05 1995 Adjustable flow rate glaucoma shunt and method of using same
6510600, Nov 20 1997 Optonol, Ltd. Method for manufacturing a flow regulating implant
6524275, Apr 26 1999 Glaukos Corporation Inflatable device and method for treating glaucoma
6533768, Apr 14 2000 Regents of the University of California, The Device for glaucoma treatment and methods thereof
6537568, Aug 11 1997 Allergan, Inc Implant device with a retinoid for improved biocompatibility
6544208, Dec 29 2000 Implantable shunt device
6544249, Nov 29 1996 LIONS EYE INSTITUTE LIMITED Biological microfistula tube and implantation method and apparatus
6558342, Jun 02 1999 MARY C WERNER Flow control device, introducer and method of implanting
6561974, May 31 2000 Grieshaber & Co. AG Schaffhausen Device for use in a surgical procedure on an eye of a living being, and method of retracting the iris
6579256, Aug 14 1989 Photogenesis, Inc. Instrument for subretinal implantation
6589203, Jan 26 2000 ATK MEDICAL, LLC Glaucoma drainage device implant
6595945, Jan 09 2001 BG IMPLANT, INC Glaucoma treatment device and method
6626858, Apr 26 1999 Glaukos Corporation Shunt device and method for treating glaucoma
6638239, Apr 14 2000 Glaukos Corporation Apparatus and method for treating glaucoma
6648283, Jul 06 2001 Adjustable ornament display apparatus
6666841, May 02 2001 Glaukos Corporation Bifurcatable trabecular shunt for glaucoma treatment
6676607, Jan 03 2000 Johns Hopkins University Intraoperative microsurgical ultrasonic device and methods related thereto
6699210, Apr 27 1999 ARIZONA BOARD OF REGENTS, THE Glaucoma shunt and a method of making and surgically implanting the same
6699211, Aug 22 2000 Method and apparatus for treatment of glaucoma
6719750, Aug 30 2000 Johns Hopkins University Devices for intraocular drug delivery
6726664, Jun 02 1999 Optonol Ltd. Flow control device, introducer and method of implanting
6726676, Jan 05 2000 Alcon Inc Method of and device for improving the flow of aqueous humor within the eye
6730056, Sep 21 2000 MOTOROLA SOLUTIONS, INC Eye implant for treating glaucoma and method for manufacturing same
6736791, Apr 14 2000 Glaukos Corporation Glaucoma treatment device
6741666, Feb 24 1999 Canon Kabushiki Kaisha Device and method for transforming a digital signal
6752753, Oct 15 1999 F A VOIGHT & ASSOCIATES, L P Brachytherapy instrument and methods
6780164, Apr 14 2000 Glaukos Corporation L-shaped implant with bi-directional flow
6783544, Apr 26 1999 Glaukos Corporation Stent device and method for treating glaucoma
6786888, May 20 1996 Medtronic Ave, Inc Low profile catheter for emboli protection
6827699, Apr 26 1999 Glaukos Corporation Shunt device and method for treating glaucoma
6827700, Apr 26 1999 Glaukos Corporation Shunt device and method for treating glaucoma
6881197, Oct 25 1996 REVISION OPTICS, INC Sutureless implantable device and method for treatment of glaucoma
6881198, Jan 09 2001 BG IMPLANT, INC Glaucoma treatment device and method
6939298, Feb 28 2002 Glaukos Corporation Device and method for monitoring aqueous flow within the eye
6955656, Apr 14 2000 Glaukos Corporation Apparatus and method for treating glaucoma
6962573, Oct 18 2000 AQ BioMed, LLC C-shaped cross section tubular ophthalmic implant for reduction of intraocular pressure in glaucomatous eyes and method of use
6966888, Jan 13 2003 Clarity Corporation Sinus valved glaucoma shunt
6969384, Jan 03 2000 Johns Hopkins University Surgical devices and methods of use thereof for enhanced tactile perception
6981958, May 02 2001 Glaukos Corporation Implant with pressure sensor for glaucoma treatment
6989007, Feb 21 2001 SOLX, INC Devices and techniques for treating glaucoma
7041077, Jul 19 2002 Yale University Uveoscleral drainage device
7090681, Sep 18 2002 Allergan, Inc Methods and apparatus for delivery of ocular implants
7094225, May 03 2001 Glaukos Corporation Medical device and methods of use of glaucoma treatment
7135009, Apr 07 2001 Glaukos Corporation Glaucoma stent and methods thereof for glaucoma treatment
7160264, Dec 19 2002 WOUND HEALING OF OKLAHOMA, INC Article and method for ocular aqueous drainage
7163543, Mar 15 2002 Glaukos Corporation Combined treatment for cataract and glaucoma treatment
7186232, Mar 07 2002 Glaukos Corporation Fluid infusion methods for glaucoma treatment
7192412, Sep 14 2002 Glaukos Corporation Targeted stent placement and multi-stent therapy
7195774, Aug 29 2001 Implantable and sealable system for unidirectional delivery of therapeutic agents to tissues
7207965, Jun 16 2003 Solx, Inc.; SOLX INC Shunt for the treatment of glaucoma
7220238, Apr 26 1999 Glaukos Corporation Shunt device and method for treating glaucoma
7273475, May 03 2001 Glaukos Corporation Medical device and methods of use for glaucoma treatment
7291125, Nov 14 2003 Alcon Inc Ocular pressure regulation
7297130, Apr 14 2000 Glaukos Corporation Implant with anchor
7331984, Aug 28 2001 Glaukos Corporation Glaucoma stent for treating glaucoma and methods of use
7431710, Apr 08 2002 Glaukos Corporation Ocular implants with anchors and methods thereof
7488303, Sep 21 2002 Glaukos Corporation Ocular implant with anchor and multiple openings
7563241, Apr 07 2001 Glaukos Corporation Implant and methods thereof for treatment of ocular disorders
7850637, Apr 26 1999 Glaukos Corporation Shunt device and method for treating glaucoma
7857782, Apr 07 2001 Glaukos Corporation Ocular implant delivery system and method thereof
7972616, Apr 17 2003 GLO TECHNOLOGIES LLC Medical device applications of nanostructured surfaces
8075511, Apr 07 2001 Glaukos Corporation System for treating ocular disorders and methods thereof
8128588, Nov 14 2003 Alcon Inc Ocular pressure regulation
8702727, Feb 01 1999 Hologic, Inc; Biolucent, LLC; Cytyc Corporation; CYTYC SURGICAL PRODUCTS, LIMITED PARTNERSHIP; SUROS SURGICAL SYSTEMS, INC ; Third Wave Technologies, INC; Gen-Probe Incorporated Delivery catheter with implant ejection mechanism
20010000527,
20010025150,
20020013546,
20020013572,
20020026200,
20020072673,
20020087111,
20020111608,
20020128613,
20020133168,
20020143284,
20020156413,
20020165478,
20020169130,
20020169468,
20020177856,
20020188308,
20020193725,
20020193804,
20030009124,
20030028127,
20030028228,
20030055372,
20030060752,
20030069637,
20030088260,
20030097151,
20030097171,
20030109883,
20030120200,
20030135149,
20030181848,
20030187384,
20030187385,
20030191428,
20030208163,
20030220602,
20030220603,
20030229303,
20030232015,
20030236483,
20030236484,
20040015140,
20040024345,
20040050392,
20040073156,
20040088048,
20040092856,
20040097984,
20040102729,
20040111050,
20040127843,
20040147870,
20040148022,
20040193095,
20040193262,
20040210181,
20040210185,
20040216749,
20040225250,
20040236343,
20040249333,
20040254517,
20040254519,
20040254520,
20040254521,
20040260227,
20040260228,
20050008673,
20050038334,
20050049578,
20050085892,
20050090806,
20050090807,
20050101967,
20050107734,
20050119601,
20050119636,
20050119737,
20050125003,
20050143817,
20050149080,
20050175663,
20050181011,
20050181977,
20050182350,
20050191331,
20050192527,
20050197613,
20050209549,
20050209550,
20050232972,
20050244462,
20050250788,
20050266047,
20050267397,
20050267398,
20050271704,
20050273033,
20050277864,
20050283108,
20050288617,
20050288619,
20060020248,
20060032507,
20060036207,
20060047263,
20060069340,
20060074375,
20060084907,
20060116626,
20060149194,
20060155238,
20060173397,
20060195055,
20060195056,
20060200113,
20060235367,
20060241580,
20060241749,
20060276739,
20070010827,
20070088424,
20070088432,
20070112292,
20070118147,
20070191863,
20070276315,
20070276316,
20070282244,
20070282245,
20070293807,
20080015488,
20080045878,
20080108933,
20080200860,
20080228127,
20080234624,
20090036819,
20090036840,
20100010416,
20100152641,
20100234790,
20100274259,
20110028884,
20110087149,
20110087150,
20110087151,
20120123316,
20120220917,
20130245532,
20130281817,
20130281908,
20130281910,
20140012279,
20140066831,
20140081195,
20140107556,
20140135916,
20140213958,
20140309599,
20140323995,
20140364789,
20140378886,
20150022780,
20150223982,
20150238360,
20150320596,
20150335487,
CN1124164,
CN1225027,
CN1285724,
CN1681457,
EP228185,
EP1184010,
EP1310222,
EP1418868,
EP1473004,
EP1477146,
EP1977724,
EP2027837,
GB2101891,
RE35390, Aug 04 1992 Pressure relieving device and process for implanting
RU2018289,
RU2056818,
RU2074686,
RU2074687,
RU2157678,
WO2013069617,
WO6223,
WO64389,
WO64390,
WO64391,
WO64393,
WO64511,
WO178631,
WO178656,
WO197727,
WO2070045,
WO2074052,
WO2080811,
WO2080829,
WO2087418,
WO2087479,
WO2089699,
WO2102274,
WO236052,
WO3015659,
WO3015667,
WO3041622,
WO3073968,
WO3099175,
WO2004014218,
WO2004026106,
WO2004026347,
WO2004043231,
WO2004056294,
WO2004060219,
WO2004062469,
WO2004073552,
WO2004110391,
WO2005016418,
WO2005046782,
WO2005055873,
WO2005105197,
WO2005107664,
WO2005107845,
WO2006012421,
WO2006036715,
WO2007087061,
WO2007115259,
WO2007130393,
WO2008061043,
WO8900869,
WO9112046,
WO9219294,
WO9402081,
WO9409721,
WO9409837,
WO9413234,
WO9508310,
WO9620742,
WO9636377,
WO9823237,
WO9830181,
WO9926567,
////
Executed onAssignorAssigneeConveyanceFrameReelDoc
Apr 29 2007CORONEO, MINAS THEODORETRANSCEND MEDICAL, INC ASSIGNMENT OF ASSIGNORS INTEREST SEE DOCUMENT FOR DETAILS 0329790225 pdf
Mar 06 2014Transcend Medical, Inc.(assignment on the face of the patent)
Jun 08 2016TRANSCEND MEDICAL, INC Novartis AGASSIGNMENT OF ASSIGNORS INTEREST SEE DOCUMENT FOR DETAILS 0389670487 pdf
Nov 11 2019Novartis AGAlcon IncCONFIRMATORY DEED OF ASSIGNMENT EFFECTIVE APRIL 8, 20190514540788 pdf
Date Maintenance Fee Events
Feb 23 2017STOL: Pat Hldr no Longer Claims Small Ent Stat
Nov 15 2019M1551: Payment of Maintenance Fee, 4th Year, Large Entity.
Jan 22 2024REM: Maintenance Fee Reminder Mailed.
Jul 08 2024EXP: Patent Expired for Failure to Pay Maintenance Fees.


Date Maintenance Schedule
May 31 20194 years fee payment window open
Dec 01 20196 months grace period start (w surcharge)
May 31 2020patent expiry (for year 4)
May 31 20222 years to revive unintentionally abandoned end. (for year 4)
May 31 20238 years fee payment window open
Dec 01 20236 months grace period start (w surcharge)
May 31 2024patent expiry (for year 8)
May 31 20262 years to revive unintentionally abandoned end. (for year 8)
May 31 202712 years fee payment window open
Dec 01 20276 months grace period start (w surcharge)
May 31 2028patent expiry (for year 12)
May 31 20302 years to revive unintentionally abandoned end. (for year 12)